Prenatal alcohol exposure represents a major public health concern, resulting in a spectrum of disorders associated with a wide range of physical abnormalities, facial dysmorphology, and neuropsychological impairments. Alcohol's adverse effects on brain development and cognitive abilities are among the most devastating consequences. Prenatal exposure to alcohol is one of the leading preventable causes of birth defects, intellectual disability, and neurodevelopmental disorders. However, despite extensive public health warnings and prevention efforts, women continue to consume alcohol during pregnancy, particularly in patterns known to be of high risk to the developing fetus. The prevalence of fetal alcohol spectrum disorders (FASD) is estimated to be as high as 2-5% of young school children in the U.S., placing considerable social and economic burdens on the individual, families, and community. These significant ramifications call for the development of comprehensive treatment programs to ameliorate the adverse consequences of prenatal alcohol exposure. Choline, an essential nutrient, is critical for fetal brain development and studies have shown that early supplementation leads to long-lasting cognitive enhancement. Animal models of FASD have also revealed that choline supplementation can reduce the severity of alcohol-related cognitive impairments, even when given postnatally after alcohol damage has occurred. Given this preclinical evidence, the goal of the current proposal is to translate these findings toa clinical population and determine if choline can effectively reduce neuropsychological impairments in children with FASD. Currently, two clinical studies are examining the effects of prenatal choline supplementation in women drinking alcohol during pregnancy as well as early postnatal supplementation in young children. However, as many children with FASD are not diagnosed until they enter school, it is essential to examine treatment options that can be effective throughout middle and later childhood. Animal data suggest that choline may still be effective even when administered during this later period of development. Thus, this study will determine whether choline can improve cognitive functioning in school age children. The specific aims of the proposal are to investigate whether choline supplementation can reduce the severity of learning and memory, executive function, and attention deficits in children with FASD. PUBLIC HEALTH RELEVANCE: Fetal alcohol spectrum disorders (FASD) is a serious public health concern not only within the U.S. but also throughout the world. Because women continue to drink alcohol during pregnancy despite known risks, there is a need to seek effective treatments that will mitigate developmental alcohol-related deficits. Animal models have demonstrated that the nutritional supplement choline can ameliorate the severity of cognitive deficits associated with developmental alcohol exposure, yet research is only beginning to examine the effectiveness of choline supplementation in a clinical population; thus, the proposed study intends to translate preclinical research of a potential therapeutic in children with FASD.